Abstract:
Myocardial Bridging represents an anomaly of the coronary circulation, characterized by a
myocardic course of a major epicardial artery. The segment is referred to as the “tunnelled artery” as
it runs beneath a layer of muscle fibbers, which varies in length and thickness. The most common site
of this anomaly is the left anterior descending artery, but it can also be confined to any other coronary
branches. The condition is clinically silent most of the times, being accidentally discovered during an
angiographic study or at autopsies. Even though usually benign, clinical manifestations vary from
ischemia to sudden cardiac death. Superficial bridges are usually of no clinical importance, while
deep ones lead to different cardiac complications. The estimated frequency varies from 1.5% to 16%
at coronary angiography studies, to 80% in some autopsy studies. While still debated whether just an
anatomic variant or a malignant condition, different pathology studies showed morphologic alteration
of the myocardium tributary to the bridged artery. Furthermore, there is evidence that the tunnelled
artery is protected from atherosclerosis, while the proximal and distal segments have an increase
susceptibility to atheroma plaque formation. The main physiologic effect of the myocardial bridge
occurs with each systole, when the coronary artery is compressed between the overlying muscle
bundle and the rest of the ventricular mass. Yet, additional research is needed to define which bridges
are life-threatening and furthermore, which are the most suitable therapy options for these patients.
Our goal was to review the literature regarding Myocardial Bridging and present two opposite clinical
cases, one discovered by chance after the autopsy and the other of sudden cardiac.
